中華民國耳鼻喉科醫學會雜誌
台灣耳鼻喉頭頸外科醫學會,刊名變更
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背景:晚期下咽癌的手術治療，通常在施以徹底的切徐後，必須使用許多複雜的方法重建下咽吞嚥道缺損。為簡化手術切除及重建的方法，我們遂根據下咽癌的侵犯特性，使用一種經喉氣管縱切的手術方法，迅速暴露並徹底切除腫瘤，同時也保留部份正常的喉氣管組織，做為重建吞嚥道的喉氣管瓣。 方法:自1991年8月至1996年12月間，我們對所有未侵犯對側喉部及梨狀竇的下咽癌病患，施行這種手術法。手術時向上以喉氣管縱切方式進入咽喉腔，在清楚視野下直接將腫瘤、鄰近組織及頸部廓清術切下的組織，做整體摘除，接著再使用喉氣管瓣完成下咽吞嚥道的重建。 結果:在這段時間，共50例病患以這種手術方法治療，沒有任何全環狀吞嚥道缺損的病例發生。其中38例 (76%)順利以喉氣管瓣直接重建其吞嚥道，其餘12例 (24%)因為切除範圍較大，尚需胸大肌肌皮瓣以補舖方式與喉氣管瓣共同重建吞嚥道缺損。術後吞嚥功能方面，除了1例於放射治療後產生咽喉食道狹窄，其餘均十分理想。在追蹤期間，均無局部復發 ; 頸部轉移有7例，多發生於未做頸部廓清術的一側。 結論:由我們長期經驗認為，本方法減低了傳統手術的腹雜性和損害性。對晚期下咽癌病患，這是一個簡單可靠、而且實用性頗高的手術方法，值得採行。
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Background : Habitual snoring spells both medical and social implications since it often signals the presence of obstructive sleep apnea and disrupts a bed parther’s sleep. This study is to compare the improvement of preoperation and post-operation of our patients who received single-stage LAUP at our department with pevious one-stage or original LAUP. Methods: We collected the patients who received the single-stage LAUP at our department form September 1, 1995 to August 31, 1997. The objectives, included the patients themselves and the people who lived together with them. The questionnaires were fulfilled by phone call visit. This is a retrospective study. The descriptive statistic and Chi square test were used for comparison of difference and relationship. Results: Thirty-seven patients were included in our study. There were 24(64.9%) males and 13(35.1%) female. The range of age was 19 to 74. The average age was 40.3±12.6. The improvement rate of snoring was 89.2%, and this group had the average BMI 25.7 kg/m. Subjectively, patients had more statistical significant improvement for both snoring and sleep quality after operation than before. Those living together with patients were also observed the same results. Conclusions: According to the above results, the patients who received the singlestage LAUP had significant improvement. We concluded that the patients who received single-stage LAUP had been more significantly improved both subjectively and objectively than previous one-stage LAUP. If their BMI was larger, weight reduction was at first recommended before single-stage LAUP. Further studies will be needed to follow-up the long-term octcomes of single-stage LAUP in mitigation or arresting snoring.
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背景:部份氣切患者在拔管後，氣切造口可能無法癒合而形成氣管皮瘻;這特別容易發生在長期管切開及嬰幼兒時期接受管切開的患者，對患者及家屬的生活造成不少困擾。本文主要回溯性討論近幾年來處理小兒氣管皮瘻患者的方法與經驗，並由取下瘻管之組織研究，討氣氣管皮瘻可能的形成機轉。 年:民國84年3月至民國87年3月間本科收集小兒氣管皮瘻病患共13例，分析患者接受氣管切開的原因、年齡及拔管時的年齡。手術採瘻管切除並多層縫合的方式。部份取下之氣管皮瘻作顯微組織研究。 結果:這些病患接受氣管開的平均年齡為29個月大;氣切造口平均維持時間為49個月;追蹤氣管皮瘻的平均時間為14個月。瘻管組織檢查發現皮下明顯纖維化並表面覆以扁平上皮，部份可發現扁平上皮與纖毛柱狀呼吸上皮連接在一起的現象。術後併發症 : 1例皮下及縱膈氣腫 ; 另1例發生感染。 結論:本報告中氣管皮瘻患者平均氣管造口維持時間超過4年，組織檢查顯示皮下明顯纖維化並表面覆以扁平上皮;因此氣管皮瘻是長期發炎造成疤痕纖維化及扁平上皮長入瘻管，使氣管造口無法癒合。手術閉合前應先以喉氣管鏡檢查，術後須密切觀察病人的呼吸狀態;可能的併發症包括傷口感染及皮下和縱膈氣腫。
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背景:小兒膽脂瘤的特性，包括有侵犯快速，侵入乳突腔多，手術及術後的照顧不易。本報告乃經由14年間三種手術的方法及其聽力結果，分析並探討何種手術方法，較合小兒膽脂瘤的治療。 方法:自1981年至1995年間，有55例小兒膽脂瘤病例，採手術方式治療。其手術方法可區分為三的類群:第一類群有10例，採用保留耳道壁法。第二類群有22例，採幅真保留耳道壁及乳突腔為開放腔法。第三類群有23例，採用不保留耳道壁且乳突腔有軟骨填塞法。比較這三類群手術方法的聽力結果及其術後復發情形。 結果:採保留耳道壁法(10例):術前平均氣導閾值約為27dB，術後平均氣導閾值約為29dB，有2例復發病例。採不保留耳道壁及乳突腔為開放腔法(23例):術後平均氣導閾值約為44dB，術後平均氣導閾值約為42dB，無復發病例。而採不保留耳道壁且乳突腔有軟骨填塞法(22例);術後平均氣導閾值約47dB，術後平均氣導閾值約為41dB，且無復發病例。 結論:小兒膽脂瘤的處理情形較為特殊且困難，一般傳統的保留耳道壁法及不保留耳道壁乳突腔為開放腔法的手術方法，並不適合小兒膽脂瘤的治療。所以我們提出一種較為簡單方便且聽力結果不錯的手術方法，即是採用不保留耳道壁且乳突腔有軟骨填塞法
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背景:眾所周知，槍枝射擊對內耳所造成的衝擊不小，但警界同仁卻多不自知，以致老來飽受耳鳴、重聽，眩暈所苦。 方法:同一單位之警察，於打靶射擊前、後，進行傳統純音聽力檢查及超高頻聽力檢查，俾兩相對照。所有警察均接受鳥茲衝鋒槍與M16步槍的射擊訓練，連續3週。打靶的同時，並檢測鳥茲衝鋒槍與M16步槍的噪音度。 結果:比較異常耳各頻率受害的程度，在傳統純音聽力檢查中，無論是右耳或左耳，皆以6kHz及8kHz處最常受害。至於超高頻聽力檢查中，則10-18kHz各音頻的異常率均超過50%。檢測鳥茲衝鋒槍與M16步槍的最大噪音值分別是104dBA及127dBA。 結論:在作射擊訓練時，須配戴耳栓，併覆以耳罩，以雙重保護聽力，避免聽性外傷。
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Background: Premature infants with very low birthweight (VLBW) differ from the full term ones in the innate, environmental factors and the health. These differences probably result in a developmental change on auditory pathway. In this article, we compared the auditory brainstem response (ABR) of VLBW premature infants with those of the full term in order to investigate the developmental difference of auditory pathwaqy between the two populations. Methods: ABR was performed on 72 six-month-old VLBW permature infants and 65 twelve-month-old permature infants. Ten six-month-old and eight twelve-month-old agematched full term infants were tested as control group. Latency (L) and interpeak interval (IPI) of ABR were analyzed. Results: The L I in six-month-old VLBW premature infants was longer than that in the full term infants (1.539 msec vs 1.478 msec). The L I in twelve-month-old VLBW permature infants was also longer than that in the full term ones (1.506 mesc vs 1.448 msec. There was no difference in L Ⅲ and Ⅴ between the two gropus. The IPI Ⅰ-Ⅲ in six-month-old VLBW premature infants was shorter than that in full term infants (2.664 msec vs 2.766 msec). The IPI Ⅰ-Ⅲ in twelve-month-old VLBW premature infants was shorter than tat in the full term ones (2.542 msec vs 2.609 msec). There was no difference in IPI Ⅲ-Ⅴ between the two groups. The IPI Ⅰ-Ⅴ in twelve-month-old VLBW premature infants was shorter than that in the full term infants (4.663 msec vs 4.768 msec), while no difference was noted in the six-month-old group. Conclusion: L I was longer and IPI Ⅰ-Ⅲ was shorter in VLBW permature infants than those in the full term infants. We considered that the prolongation of L I might be due to the higher incidence of otitis media in the VLBW premature infants. Longer extrauterine life duration of the VLBW premature infants might contribute to the shortness of IPI Ⅰ-Ⅲ
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背景:過敏性鼻炎與血管運動性鼻炎患者分別具有不同的下鼻甲黏膜變化。本研究希望瞭解以此種變化來鑑別診斷過敏性鼻炎與血管運動性鼻炎的可信度有多高?是否具有臨床價值? 方法:自民國83年1月至12月對澎湖地區7599名國小學童，其中3941名男性、3658性女性，年齡由7歲至14歲，進行本項研究。經疑似病例分組及對照組選定後，以前鼻鏡檢視下鼻甲黏膜變化，並以此為變項來探討不同鼻黏膜變化(紅色無腫脹、蒼白無腫脹、蒼白且腫脹、蒼白腫脹且有水性分泌物及藍色鼻黏膜)對過每性鼻炎及血管運動性鼻炎的診斷程度及血清全IgE濃度。 結果:不同鼻黏膜變化對診斷過每性鼻炎及血管運動性鼻炎的敏感度階低，但專一度及陽性預測值則非常高。陽性預測值較具有臨床價值，由本研究可知:當吾人以前鼻鏡檢發現為蒼白無腫脹的下鼻甲黏膜時，有78.6%的可能性推論此為罹患過每性鼻炎的學童;發現為蒼白且腫脹的下鼻甲黏膜時，則有91.6%的可能性可推論此為罹患過敏性鼻炎的學童;發現為蒼白腫脹且合併水性分泌物的下鼻甲黏膜時，則有98.4%的可能性可推論此為罹患過敏性鼻炎的學童;而當發現為藍色的下鼻甲黏膜時，則有72.1%的可能性可推論此為罹患血管運動性鼻炎的學童。此外，當下鼻甲黏膜變化愈明顯時，其血清全IgE農度也愈高。 結論:低敏感度懷不宜以下鼻甲黏膜變化作為過敏性鼻炎及血管運動性鼻炎的篩選工具，但高陽性預測值則使得下鼻甲黏膜變化的確可作為過敏性鼻炎及血管運動性鼻炎的鑑別診斷之用。